HomeMy WebLinkAbout871 VICTORIA ST - Building Permitsr �
� S CITY OF COSTA MESA
�,��pMFs'q BUILDING DIVISION .
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F�,,,,, `., � 77 FAIR DRIVE, COSTA MESA, CA 92626 • Qt4) 754-5273 • Faz p74) 754-4856 • www.ci.costa-mesa.ca.us
�. FOR INSPECTIONS CALL: (714) 754-5626
`°�^°^�°"` PERMIT NUMBER: M11-00091
PERMIT TYPE MECH
APN: 42245218
JOB ADDRESS: 871 VICTORIA ST CM
vicinity:
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 09/13/2011
ISSUED BY: KJB
Suite/Unit:
SCOPE OF WORK: INTALL NEW FAU IN CLOSET AND ADD DUCT WORK' NO CONDENSOR ` 60K BTU `. GAS PIPING FOR
UNIT. 1 VENT THRU THE ROOF.
OWNER:
PHONE:
APPLICANT:
PHONE:
WATERS, TARA
TOMCAT MECHANICAL INC
7'14-434-6985
CONTRACTOR: TOMCAT MECHANICAL INC
Address: 23�51 ALCALDE DRUnit SUITE C-4
City/State: LAGUNAHILLS,CA ZipCode: 92653
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MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $65.40
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $65.40
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Address: 871 VICTORIA ST Unit:
City/State/Zip: COSTA MESA, CA
Address: 3303 HARBOR BL Unit:SUITE H3
City/State/zZip: COSTA MESA, CA
License No. 706371
PHONE: (949) 273-6220
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes antl related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: PERMI7 EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered iegal, such work must comply with ail applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of lhis permit.
161�6 � IF xed SystemEFinql Fire Prevention DATE INnnnls 206EN IFirnaEl Mec anEcal A INitT1AL5
i - -ia ��
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Pinal Block/Retaining Wall 212 Final Fire Prevention
2�2 Final Pactory Fire place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolilion 250 Final Building/Occupancy
{� ,
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalry of perjury one of �he following declarations:
❑ I have and will maintain a certifcate of consent to selGlnsure for vrorkers'
compensation, as provide0 for by section 3700 0( the Labor Code, for the
erformance of the work (or which ihis pertnit is issued.
I have and will maintain wnrkers' compensation insurance, as required by
c n 3700 0( Ihe Labor Code, for the perfortnance of Ihe work (or which Ihis
permit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
�"drtiEl"' M�
� issedonneeE q10eOmpleletlQ�IM1'ep�e�mR/isvaluedafoneh ndiretldollars(5f00)orless.)
ol y Numtier. O � 3 u J ii '�� �G
❑ I cehify that in the performance of ihe work (or which this permit is
issued, I shall not employ any person in any manner so as to bewme subject
to Ihe workers' compensalion laws of California, and agree that if I should
become subject to the workers' compensation provisions ot Section 3700 of
Ihe Labo��lsFrd hwith comply with these provision
_��_ � l3�(,
nYs ignaWre pata—J"
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed untler pmvisions of Chapter 9(commencing
with Section 7000) of Division 3 of Ihe Business and Pmfessions Code, antl
my license i in full force and effect.
��0 .�� �
n
a re����„re. at'a
CONSTRUCTION LEND�NG AGENCY:
❑ I hereby affrtn Ihat there is a consWction lentling a9ency for the
per(ortnance of ihe work fa which this pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
Signature �a�e
OW NER-BUILDER DECLARATIONS:
I h¢reby affirm �hal untler penalty of perjury that I am EXEMPT FROM THE
CON7RAC70RS LICENSE LAW (or the following reason (Sec. 703L5,
Business and Pmfessions Cotle: Any city or counry which requires a permit ro
construct, alter, improve, demolish, or repair any stmcture, pnor to its
issuance, also requires the applicant for such permit to fle a signed 5tatement
Ihat he or she is licensed pursuant to �he provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is ezempt therefrom antl
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permi[ subjects the applicant to a civil penalry of not more than
frve hundretl dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
wmpensalion, WILL DO THE WORK, and Ihe strucNre is nol intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, antl who does such work himself or herself or thmugh his or her ovm
employees, provided tha[ such improvements are not intended or oftered for
sale. If, however, the building or improvement is sold within one year of
complelion, the ownerbuilder will have lhe burden of proving that he or she
did not build or improve for purpose of sale.�.
❑ I, as owner of ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to consWcl the project (Sec. 7044. Business and
Professions Code: The contractors License Law does not apply to an ovmer of
property who builtls or improves thereon, and who con�rac[s for such projecl wi�h
a cont2ctw(s) license pursuant [o the CoM2c[ors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID verified by drive� � ncense. ❑ Yes ❑ No
Driver's License No. 1 � Expires:
Verification of Ownership by (type of document, i.e. - pmperty taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ i hereby certify Ihat no excavation fve (S) or more feet in depth into which a
person is required to descend, will be made in connectbn with work authorized
by Ihis permi[, and �hat no 6uiltling structure, scaf(oltling, lalsework, a demolition
or dismantling �hereof, will be more [han [hirty-siz (36) feet high. (Chap. 32, Grp
2. M 2, Sec. 341. 7�1e 8, Califomia Adminis�rative Code�.
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division of Intlustrial Safery, as noted above, unless
such peaon has a permit to tlo such work from the division.
Appliwnfs SignaWre
Division o� IndusUial Safety Permit Numbec _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
t. Will ihe applicant or present or fuWre building occupant need to file and
certify a Business Plan (or emergency response to release or Ihreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of �he Califomia Healih and Safety Code requires, with some
exceptions, Ihat a Business Plan be filed wi�h lhe Cos�a Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard lemperature and pressure).
2. Does or vnll the applicant or present or (uture buitdinq occupant need to fle
a registration form tor acutery hazardous materials? ❑ Ves ❑ No
(Section 25533 0/ the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one �ime has on hantl a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic (eet of compressed gas at standard
tempereNre and pressure).
3. Does or will the applicant or presen[ or (uture building occupant need [o
prepare an RMPP (Risk Managemen� and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 ot the Califomia Health antl Safety Code provides that the
Cos[a Mesa Fire Department may require Ihe preparation, ceriifcation and
(iling with the Fire Department of an RMPP by businesses which are required
[o regisler acutely hazardous materials with ihe Fire Department.
4. If an RMPP i5 pre5ently requiretl, has SeCtion 25534 of the Cali(ornia
Health and Safety Code been (ully complietl with? ❑ Yes ❑ No
5. Does or will the appiicant or present or future building occupant require for
Ihe work which is Ihe subject o! this application a permit for such construction
or modlfication from the Soulh Coast Air Quality Management District or from
any other air pollution control tlistrict or agency? ❑ Yes ❑ No
(Section 658502 of the California Govemment Code requires Ihat the requestetl
infortnalion be fumished on applications (a noo-residential building pertnits).
6. Will any part of the facility to be constructetl under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes". the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Sa(ety Code).
7. If a permit (rom the Sou[h Coast Air �uality Management Dishict or other
air pollution conirol distric� or agency is requiretl for the vrork which is Ihe
subject of [his application, have all o( the disclosures prescribed 6y California
Health and Sa/ety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certifcate o( compliance from Ihe appmpriate air pollution
conUol offcer).
CERTIFICATE OF COMPLIANCE: 1 certify that under penalty of perjury the
information given above is correct I agree to comply with all state laws antl
ciry ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this appliwtion and s[ate that
Ne information given is correcL I agree to comply with all state laws and city
ordinances relating to building construction, and authonze representatives o!
ihe City of Cosla Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until final inspeclion.
Signal Owner Dale
Signature Daie � � /2
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❑ InJuorCoil �SEL�ft ❑ iISPF ' % (//um nlrenrh� prc.��cuc uunv La . .
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• � cenify thal Ihis Cenificnte o1'Camplinnce documeNatiau is aecum�e und complete. ` � � � . � � �, . . . � �
• I am eligible under pivision ]��of Ihe. C�lifonun business and. Protessions Code tn accep� respmisi6ilitp ior �he desiym identifieA �nn thi;
CeniGcale oi Complianee. � �� � � � � � � , � . . .. ��
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compliance lorms, worlsl���lc,.enleulnlionc,.plan: and speciCie� tions su6mmed�t6lfie en(oreemeni ugency fornpprnved with I�ie.permb . .. .. ... .. ... .
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2U(}8 P.ttiitfiu� �nerrp.�'I:`ficie�nr.;y St:mclo-trds iZesidentiaf C(\�.AC .�tlt:erxtinnt
C�[im<4t:c: Guiiex 1.inti 3 l:l�u•oi��fi 7 GZ�-6 : �.asr�l �n�sr�
Ri15IN�S6 ANI) PI20%'L+9S70NS C�L. S�CTI01�' 71:t0
Willful or deliber¢u: die�•egard and vi<il4tiou of thr. buildinE�, laws, inr.luding the Ctdifomia Fluilding Codc, anA
Incul permir requiremenu conatitutes a ouuae. fnr disciplinnry �etion from Ihr. Comractnr:: Stmr.l.ir.enxr. F3om�d
wni7cing in caiijwictiqn wiih tlie looul Uuilding department. This actiom m�y cansisl af fi»e� up t<i 9:5,110(1 per
vmintion �x auxpeusionlrr.vocation A( a cona�uctoi''s licen4e. �
�i'ITLM1' fS A )'�I2M1'1' 12�(1T7D:r17?
A written co�tetrueti�n permii shull hr, �hcained C}•om the eoforcement agr.ney prior to the erectinn, eonFmuCtinu,
renousn'uc[imi, insttdlation, relncation, nr afieration 6f nn�� mechtmienl yystem, exr.apl as pennitted.in Appeurf ix
Chiq�fer 1�, Section ! 12 � of ti�r. 200� C�lifnrniii Meclmnicul Code. Pmlects requiring permie� iuclade, hui ai•c noi
limucd to:
• IJaw ENAC installution
• HUAC Cl��u�;eoul �
• 12.nplucemeui oP fimiace, coil, PAC), ��r cnnden�;er .
�• Relocation of an exiating FTVAC; unil .
�• Adcliug ar replucing marc thatrhOPi dueting"iu unconditianed spxae.
1, Heating equipment mua� have a minimum 78%AFUE (Exceptian: Wall K floor fiirnaces; room heaters).
:I. Cenn al air conditioners & lieat pumps.less than 6�,(HH) Btufhr must hnve a minimum I 3 SEER.
;. Newly instaUetl or replaced ducts must have a minimum insulation value oClt-A.'L.
4. A setbacl; type thermostat (24 hr clocl< with Fnur set poinls} is required for all alterations.
i. New or repfacement ducts must meet the mandatorv reyuirements oT Section 15p(ml'
•• AII joints and openings in the in the ETV AC syscem must be sealed.
�• Oniy UL 1 Sl, UL 1 S1A, or UL 1 RiA approvecl tapes or mastic shall be useA tn se�l duoi openings.
�• Connections of inetals ducta and the �tnner oore of fler, ducts shall b� mechanically fustened, Fle�: ducts
musi be connected using a metal sleevefcoupling.
^ Fle>: ducts ihai nre suspended musl be supported every 4ft, ma>: fon c�ieizcmtAl nm° with no more Chan :"
' of sug heeween supp�rts and b ft. maa'. &x vertieal runs.
6. 'fhe Cr-(It-MI:CS-04 musi he compSeted and siened b}� ttie installn�� wnttacior. The lnspector wiil collect
this forn�i and verif;� fnai the model numbers are Ihe same as the insr;illed equipment.
(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.cg�ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 871 VICTORIA ST Status: ISSUED
Suite: Applied: 10/25/2005
Vicinity: ROOF Issued: 70/25/2005
Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N
Parcel Number: 42245218 Zoning:
npplicant: ROD FORD
Address: 16 CAPSTONE
Phone: 949387-9428 ISSUED BY:
IRVINE, CA Zip: 92606 �
Owner: PRICE, ROSE J �
Address 871 VICTORIA ST `
Phone: �
COSTA MESA, CA Zip: 92627
Contracror. BIUE SHOE ROOFING
Address: i6CAPSTONE �
Phone: . 9 - 87-9428
IRVINE, CA�-
Zip: 92606
ArCh :
Address:
Phone:
License: 810900
Eng:
Address:
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 30# FELT, 30 YEAR COMPOSITION SHINGLES, AND REPAIR/f2EPLACE SFIEATHING AS
NEEDED. 20 S�UARES MCLUDES ATTACHED GARAGE. �
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: Sa,so�.0o
Permit: $11125 Claim Valuation: $a,so�.00
SMIR Res: $0.50
SMIP Cam: $D.00
Othec $0.00 ;
Inspection: $0.00
Total: $111.75
PLANNING 8 ZONING
SETBACKS
ACCESSORY
PARKING
Front 0- 0
Front 0-0
Existina: 0
Rear 0-0
Rear 0- 0
Reouired: 0
Left 0- 0 , Right. 0- 0
Lefi 0- 0;, - - Right 0- 0
Pr000sed: . 0
NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under California statutes and reiated
regulations. (Ortl. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. '
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inepeetlona entl final approvel must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545828 ,
2a&AB (8N0) - � — -
WORKERS'COMPENSAnON DECLARATON: . � �
I �ere6y affirm under penelty ol perjury one of the f011owing tleclaretion5:
❑ I heve end wlll melntain e certificate of consent to selt-Insure tor worker5' compensation, es pravided fOr by seCilon 3700 of the Labor Coda, for Iha peAormence af Ihe
�work for which Ihis permit is Issued. �
�t �. {.have entl wlll maintain workars' ensation insurence, es required by section 3700 of Ne Labor Code, br Ne peAormance of the work for which Ihis peimit is issued.
�-"My workers' ompe sation Insura c n�ier end p Icy number eie:
�arrier �'�� � Policy.Number. � 7 � �y _��
(�Tfil�ecNon neetl not be cromp/efed i! the permit is veluetl et ne huntlred tlollers ($100) or less.) � _
❑ I certity thet In ihe pedormance of the work for which this permit is issued, I shall not employ eny person in any manner so as to become sub�ect to the worker9'
compensetlon laws ot Califomla, end agree thet' oultl becoma sub�ect to the workers' compensetlon provlsions oi Sectlon 3700 ot the LaDor Code, I she0 forthwith
comply with these provislons. � �—
Applicant Sipnature:-- - � �� �2 �.pate:�� = � � t Z�
NINp;�FA1URES0 SECUPE WORKERS' C(MIPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBIECT AN EMQ{�.OYERlO GRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED
' �OILARE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAA44GE5 PS PROVIDED FOR IN SEGTION 31080F THE UBOR ODDE, INrEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
of Chaptar 9(commencing with Section 7000) of Division 3
Cotle, antl my Iicense is in full
CONSTRUCTION LENDING AGENCV:
❑ I hereDy ettirm �hat ihere is a constructian lending egency for the pedormance of the work tor which this pertnit is issuad. (Sec. 3097, Civil Cotle).
Lentlers Name: Lender's Atltlress:
Signeture:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby ettirtn Ihet under penalry of perjury ihat 1 am EXEMPT FROM THE CON7RACTOHS LICENSE LAW for Ihe following reason (Sac. 7031.5, Business entl Protesslons
Cotle: Any ciry or counry which requires e pertnit to construct, alter, ImproOe, tlemolish, or repair any strucwre, prior to its issuance, also requlres the epplicant tar such pertnit
ro file a signetl statement thet �e or she is Iicensed pursuent to Ihe provisions of the Conirectars License Lew (Chepter 9(commendng with Sectlon 7000) at Divislon 3 of t�e
Business end Professions Code) or thai ha or she is exempt therelrom end the basis tor the ellegetl e:emption. Any violation oi Sectlon 7031.5 by eny applicant for e pertnit
su6�ects Ihe epplicant to e civil penalry of not more than live �untlretl tlollers ($500).):
❑ I, as owner ol the properry, or my employees with wages es lheir sole compensation, WILL DO THE WORK, ena Ihe structure Is not Intended or oMeretl for sale (Sec.
7044, Business and Professions Cotla: The Coniractors License Law does not apply to en owner ol property who builds or improves t�ereon, antl who does such work
himself or hersell or ihrough his or her own employees, provided ihat such imprwements era no� intended or oflered tor sale. Ii, however, Ihe building or improvement is
soltl within one year of completion, the owner-builder will have �he burden of proving ihat he or she Gitl not build or improve for purpose ot sale.). �
❑ I, as owner of lhe property. am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to cansiruct the prol�� (Sec. 7044, Business enC ProfeSsions
Code: The conlrecrors License Law tloes nol apply to an owner of property w�o builtls or Improves thereon, end who conlracls lor such profact wlth e conlrector(s)
license pursuent to the Coniractors License Lews.).
❑ I em exempt untler sec.
Signa�ure:
Owner ID verilied by drlver's license. ❑ Ves ❑ No
Business entl Professions Code for this reason:
Verification of Ownerehip by (type of tlocument, i.e. - pmperty tez blll or daed):
DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION:
Orivers License No.
Dale:
Expires:
❑ I heraDy cenity t�et no excavetion five (5) or more feet In depih into which e person is requireA to descentl, will be made in connection with work eut�onzetl by Ihis
pertnit, and ihat no building struclura, sceHolding, falsework, or tlemolition or dismantling thereot, will be more than thirry-six (36) feet high. (Chap. 3.2, Grp 2, Ar12, Sec.
341, Tille 8, Calitomia Adminisirative Cotle).
❑ As owner-builder, I will not employ anyrone to tlo work w�ich would require a pertnit trom the Division ot Industrial Safery, es noted above, unless such person has a
permit to tlo such work trom ihe tlivi5on.
Signature: Date:
Division of Intlustnal Sefery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUiHORVA710N OF ENTRV: I cenity under penalry of perjury thel I heve read ihis aDP����ion antl state that �he Infortnatlon given is
correct. I egree to wmply with ell state laws entl Gry orCinances relating to Cuilding construction, end euthodze representatives of Iha Clry oi Costa Mesa to enrer upon the
abova-tlescnbetl propeny tor inspection purposes. I egree not to occupy or ellow occupancy of eny building euthonzed by �his permit until finel inspeclion.
COQE 1. INSVELTIONTYVE
1616 Fixed System Final Fire Prevention
1286
200
201
202
203
204
Pool Spe Final .
Final Re-Root
Finel BIocWRetaining Wall
Final Factory Fire Place
Final Sign
Finel Demalition •
QAIE
(0 28��7�
����Qp[a INSPECTIONTYVE
208 Final Mechanical
20B Final Plumbing
210 Finel Electrical
272 Finel Fire Preventlon
�220 Final Plenning Approval
222 Final Siie
250 Final Building/Occupency
�7\I�IlIhIG1F'�
�
�
�
/
'J
PHOJELTPDOflE55: 8'�S VICTORIA JrT
OWNEH'SNRME: PRICE WILLSON H
aooeess: 871 VECTORIA ST
COSTA MESA,CA 92627
ANCHIENGINEEfl: 6 4 5— 9 Z 4 7
AOOflE55:
HEG.NO.:
UNIT:
UNIT:
PEHMITTEE: NOCK PLUMBING ( 714 ) 695-1246
aooncss: 1'1j'6J�10'j'nSEABOARD CIR
LICENSEO CONTNPCT0�6EClAflFiIdNN I nereUy aifirm mat I am licensed unuer p wisioS�ol�hBapPr 9(commencinB w��h Setlion
7qp� o� Divivon 3 0l ihe Business antl Pmiessions Catle. and my license is in lull �orte ana eifect.
cirruc.: 050386 SipTELIC.:S1S9%S /�"SS` C—�B'�
Oate�_ Signaiure:_/� �—J.1� —�
WOBKFflS' COMP NSA ON ECLAflATION: I hereby a��irm thal I have a certi�itaie 0� con5en� Ia 5ell�in5ure or a tefii�itate ol Wofkers'
Compensa�ion Insurance, or a cetlilietl copY �hereol �Seciion 3800, la�. C).
roucvNo.: 1167992-93 E%P.ORTE: O3/OZ/94
comrnxv: STAT E
❑ Cetlilietl copy is herehy lumi5hed. � Ceriilietl copy /isfjIertT/v �ih�he city Bui�A�g \�rvision.
Date: �j pPDlicani(� l��� J� C
E%EMPTIONFflMWOPBfPS'COMPENSFTIONOECIAflATION: (Thi55ettiDnneednoibeCOmplet¢tlil�hepermili5�oronehunareU(811q�orle55�.
I cetlily Ihal in Ihe pedormance ol I�e work �or w�ic� Ihis permit is issuetl. I shall nol employ any person in any manner so as lo become
su01et1 IO Ne WOrkers' Compen5alion Laws ol Calilamia.
Date: SignaWre:
NOTICE Ii, a�ter making �AiS Eeclaraiion, you s�oWE become su�lect to the Workers' Compensa�ion O�ovisions ot ��e La�or
Cotle. you musi fotlhwith comDly wil� such pmvisions or Ihis permit s�all be Oeemea revoked.
LONSTBUCTION LENOING AGENCY: I nereby allirm Ihat there is a consimction lending agency lor the oetlormance of Ihe work for
wnicn I�is oe�mit is issue0 (Sttiion 3W7. Crv. C�.
LENOEX:
ROOflESS:
OWNEfl BUILOEfl DECLABRTION: I hereby atlirm iha� I am exem0� �mm ihe Contrac�ors' $Iate license Law �Or I�e �dlowing reason
(Section 7031.5 Business an0 Pmlessional Co�e: Any ci�y ol county w�ic� repuires a permil Io consimet, al�er, improve, Oemolis�, or
repair any simclure, Drior lo ils issuance. also reQuires Ihe aD0licani fo� such permil lo ble a signetl sia�emenl Iha� he/s�e is licensed
pursuam to the pmvisions oi ��e Comracmrs' State License Law (C�apter 9 �commencing wit� Section 7000� of �ivision 3 oi the Business
antl Pmte5si0n5 CoOe) Or I�ai �e/She is eh¢mp� ��erelmm and �he ba5is br Ihe ail¢getl ex¢mpiion. Any violalion ol Setiion 7031.5 by
any ap0�icani lor a permi� SUGlec�s I�e aOVlicdni lo a civil penal�y o� not mor¢ t�an Irve �unarea dollars (f5110�.
I, as owner ol t�e pmpeny or my employees with wages as iheir sole compensation, will Ao ihe wark, antl I�e
❑ slmclure is not inlentletl or olleretl lor sale (Section 7044, Business antl Pmiessional COJe', TAe Comractors State License Law
Uoes no� apply to an owner oi a pmperiy who 6ui105 or improves thereon, antl who does such work himselll�erseli or ��muA�
his or �er own emplayees, pmviaeA Ihai such impmvemenls are nat inlendetl or oflered lor sale. II, however Ihe 6uilding or
impmv¢ment is 5014 vnlhin On¢ y¢ar ol Compleiion. Ihe owner will have Ihe burden 01 D�Oving Ae/She JiA nol huiltl or imDmve
lor ihe pur0ose oi sale�.
I.as owneroll�e propehY.am exdusively coniracting wilhlicensed coniractorsto consirucl��e prolec��Section 7044, Business
❑ antl Pmlessions CoOe: 7he Coniractor5' State License Law does not apDly to an awner ol OmDeny who UwIUs ar improves Ihereon
ane who contrans tor such pmlecis vA�h a convactor(s�license pursuantto ihe Contracmrs' State License Law�. I am aware
I�ai D�ool oI Iheir Workei 5 Campensation insurante S�oV10 be pmviEea Io me.
� I am e�empl under Seclion'. B. 8 P. C.
loi Ihis reasonl
oa�e: Owner.
I ao nereay cendy inal I am aware of and untlerstana Ihe requiremenis of Califomia Heallh and Salety Coee Sections 255Q5. 25533. an0
2553d antl �Aal I or any lutwe �uil0ing occu0anl will/will no� �circle one) neea lo comDly wilh sai0 slaie coees antl IOe reQuiremen�s for a
permi� �ai conslmction ar modilica�ion Imm Ihe Air Oualiry Management �islrict. flevaen�ial mnslm[�ion appliw�ions are ¢[empl Irom
t�ese O�ohsions.
�a�e: ADP�icanc
I here0y cerlilyihal I have rea�t�is application antl stale tha� I�e a0ove
ortlman[esantlstalelawSrelatingloDuildingcon5lmclionaMh t�
pmper�y loi insp¢U a purpo e5.
oai�: s�q�ai re:
oriver's L¢ense or Social Sewriry x:
mation is correct. I aA�ee �o comply wi�� all ciry antl counry
re0resen�atives o�l�is cilyio enlerupOn NeaEove-men�ioneU
16aL46 WNie—Bviltling: Greon—Cotle Enlorcemem: Canary—Applicanl; Pink—Revenue; Galaenrotl—Nssessor
CZTY OF COSTA MESA — BUILDING PERMIT PERM NO: P 064510
PERMIT NO; P 064510 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : CHANGE OUT OF A WATER I-IEATER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WOAK AUTHORZZED BY THIS PERMIT
fE iE 1f if f! iE 1f k M M if �f i! if iF k at it M M iE if it iE if fElf if itlE iE if iE 1f if �F iF if if It iE if iE fE 1E iE iE if 3f if 1f * if if it if iE if % �E if M 3f 1F iE 1E jE 1F if 9f aE jf if iF iE 1E iE 1F if
Z O N Z N G R E Q U I R E M E N T S
S E T H A C K S
MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FR—NT— FT IN REAR: FT IN FANT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 42245218 ZNE; REF NO:
PLANNING NOTES>
i
********�r****�t+t�*********�r+t�r**�-*****�r*r**rt+�**+t��***+t+t�***�**�+r+�*****�t***+t*�*+t**
D E V E L O P M E N T S E R V I C E S.'' R E Q U I R E M E N T S
•I .
ZONING APPROVED BY ` DATE:
BUILDZNG APPAOVED BY : ' DATE:
APPLZCATION ISSUED HY: 5-�, DATE: �c �
1E�EjE%iEilMkkiEitiEifi4ftffiEiFifitltki�iF7F�t�F�F�F�f3FiF���' ��TF�jF{4�fKifiGifMifKif ifif
1E jE iE fE if 1k if 1E 1E iF �t k if M it if !E!F �F 4 if iE it M it f! 1E iE * jf !E 1E 3E iF jf if iF if iF it i! iF 1E ff 1E 1E af if iElE iF if jE 1f fF iF if af iE 1f if if iE iE if if iF aF if if if it iE k if K iE k iE
LEGALIZATION;N F E E S U M M.A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMZP/RES GRADING
PERMIT 7,00 l
25Y \SMIP/NON—RES
PLAN �
ISSUE FEE 20.00 �
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL 'PAID DUE
TOTALS----> 7,00 20.00 0,00 27.00 27.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
27.00
iE iE iE %if if 1E ik M it!! 1E if �E k 1f 1f iE if if it iE 1E iE iE 1f 1! iE iP iE iE it if iE iE iE 1E �E iF k iF if M M if iE if iF iF iF 1E iF iE k if M if iE �E 9t iE iF aF iF iF iE iE iE if iE K iF if If M iF if iF iE
Z N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 7,00 7.00
END OF FEES
01 441;9153—OL'149153 T �� T 27.00
DATE: 10/19/43 TI11E: 11:47
CONSTRUCTION ANDPLANNING POO� �PA
APPROVALS Permit # Date Inspector pPpROVAIS Permit � Date Inspector
t. Temporary Electrical Seivice or Pole 52. Poo� & Equipment Location '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ,
3. Electrical Conduit Utihty•Undrgrnd. 54. Forms
4. £!ettrical Conduit•Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Pi�mbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAI TO COVER-GUNITE
7. Pootings 5&. Electrical Conduit-Undrgmd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. �
70. Structural Floor System 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptoi�Final �
12. Sewer Cap 63. Heater & VenbFinai
13. Roof Drains 64. Piumbing System - Final
74. Rough Plumbing 65. Electrical-Final �
75. Rough Electrical-Conduft 66. Solar SYstem�Final
16. Rough Electric Wiring 67. Fencing & Access ApP��val
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Etectricat-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Av Condit�bning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPR4VALS � Permit � I
21. Oucts, in Structure ' 70. Undergrountl Hydro � �
22. DucTs, Ventilating 71. Product Piping O Gas ❑ Od
23. Ga: Pipe-Rough & Test ' 72. Underground Flush
i
24. Roof Praming � 73. Undergrnd. Storage Tank O Gas ❑ Od
25. Root Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structurali & Monocoat 75.'Dry Chemical �
27. Frame and Flashing 76. Dry Standpipe .
28. (..athing & Siding �, � - 77, - FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing � �HEALTH DEPT. REQUIREMENT '
37. Plaster Brown Coat � 79. �FINAL INSPECTION
32. Electrital Power tvlerer�Final 80. FOOD CERTIFICATE ISSUED �
33. Final Eleciric Noies:
34. Final He�ting & Air Conditioning
35. Final Gas Pipe.Tesi `
36. Hood or Ganopy , �
37. Final factorY Fireplace � .
38. Final Plumbing . ����/��,���/� . - ----
:i -
39. Water Service-Final � �
40. Gas Service-Final . .
41. Solar pomestic-Final
42. Backfbw Preve�ter -
43. Backflow Irrigation
44. tandscape Irriqation System . � ,; • ,
45. Sound Attenuation � �
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING .
48. FINAL PLANNING
49. Electric Release to Edison �
50. Gas Release to Southern Caiifornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�
�
ADolicant to fill In all spaces enceo< <�ose witnin neavy eoraer Iines antl si9n ali aoVrovriate tleclara[ions.
CITY OF COSTA MyFs7Fj CQf�STR UCTI(��[J��� PERMIT °°�""�T °�" TAerr n�n i nT n�n � i.�ir ..�..
� Project Atldress fS I �j��.�(,;,/_
-v �c /���
Appiicant's Mailing Addie� __.���u}�—Q'S�TLXJ/�__G. ��[�py,
Owner's Namep�/ � �Q����,� ��^f�y�—/J�Phone(��.� po
Address —Q_f_�/��[7�/f� L�! ;SL[Ytl��j
Arch/Eng. License No.
Address � /�����q
ConVactor'sName �,p' � //� ��� Pho�ngn/�/_YJJ��i
Addresilmal'ngl ��� /-�•(�—��ld1,/1�� �-��+.r!!.����u
City License No. _� "')_ �� 7
LICENSED CONTRACTOR DECIHRATION
I hereby altirm fhat I am licensetl untle� provislons ot Charte� 9(commencing
with section �000) ot Division 3 of [he Business antl Professions Cotle, anA
my license is in fun force a ette t. L%••�,a3V Va
Licens C}�ss Li<ense No.
Date �/ ��1 5�9 t �ri+Aw/�.u' : e.✓� 1/�w.�
WOR�S'C MPENSATION DEC RATION
I hereby aitirm that 1 have a certificat of wnsent to selt-insure or a certificate
of. Workers' Compensation Insurance, or a certltieil copy thereof (Section
a � - "� `° 6?- �-g__�Y�
,oY Nao: fJ G'a � �o a� L nrt.si?�y
Certifietl mpy iz hereb fur ahetl.
Certi " apy fil tl with Ne city Buil ing Division.
ate APplicant�'y� �-�`�
EXEM ON OM WORKERS' COMP SATION DECLARATION
(T�is section neetl not be completetl if itt ermit is for one huntlretl (E100) or
less).
1 certify tnat in the pertormante Ot the work fo� which this pe�m�t is ISSuetl, I
shall not employ any person in any manner so as to betome subject to the
Workers' Compen5ation Laws of Califomia.
Date Signature
NOTICE: Ii, af[e� making this tletlaratlOn, you shoultl become Subje[t IO Ihe
Workers' Compensation provisions ot the Labor Cotle, you must forthwitn
comply with su�h provlzions or this Oermit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby aiFl�m that lhGre is a mnsl�uction lentling a9enty for thG perto�mance
of tne work tor wnich tnis permit is issuetl (Sectlon 3097 Civ. CJ
�entler'S Namo
Lentler'z Aatlress
OWNER BUILDER OECLARATION
I hereby altirm lhal I am exempt from [he Con[ractor'S Li<ense Law for the
.,.�� .......... ...�.,.., ice.�i.... �mi s a��cina« ann Grnfe<zinnal Code: Anv citv o�
to
to /ile a slgnetl statement ina� ne/sne is ncensea punuam n y�o.u�oin v�
[he Contractor's License law (Chapter 9(commencin9 with Section 7000) of
Division 3 of [be Business antl Professions Cotle) or tha[ be/sh0 is oxempt
there/rom antl the basiz far the allegetl ezemption. Any violation oi SecUon
'71.5 by any applicant fOr a permit subjects the appliWnl lo d civil
��ally of nol more Ihan five hunOretl tlollars (E500).
.�I, ds owner ol the pro0erly o� my Omployee5 with wages a5 [h0i� sole
comp¢nsalion, will tlo the wO�k, antl Ih¢ st�uclure i5 not Intentl¢G O� otferetl
for sale (Set[ion 7044, Buziness antl Protessional Code: The Contra<tor's
License Law tloes not aPp1Y to an owner of a Oroperty wno bulltls or improves
theteon, antl who tlo¢5 such wOrk him5elt/M1e�S¢It o� tnrou9� hi5 Or M1e� own
employees, provitletl [hat such imDrov¢ment5 are not intentletl Ot offeretl (or
sale. I/, nowever, the builtlin9 or imo���ement is soltl within one ycar ot com-
pletion, tne owncr wlll have the burtlon ot proving he/she tlitl not builtl or Im-
prove for the purpose o( sale).
❑ I, as owner ot the property, am excluzively contractln9 wltn licensea con-
tractors to construct the prqect (Section 7044, Business antl Professions Cotle:
The ConVacloYs �icense Law does noi applY to an owner ot property who
builtls or Imoroves thereon. antl who contractz br such oroiects with a con-
tractor(s1 bcense pursuan[ m me Conttacror'S Li<ense �awJ. I•am aware tnat
proof of tM1eir Worker's Compensation insurance shoultl be prOvitletl to me.
❑ I am ezempt untler 5ection B. & P. C. for this reason
Date Owner
I hereby certify Ihat I have reatl this application antl state Nai the above
informatmn is correcL I agree to comply with all city antl coun[y ordinances
dntl State IawS reldting to builtling con5tru<tion, dnd h¢reby authorize repre-
sentatives of his ciry to enter upon ihe above-mentionetl Property for
Inspection pur oses.
Signahre ' — �V— Dat¢ 9/�0,�
Drlvers' Li se or 55 � [���._
-
OB65-46, r. 5/88 White - Builtling; Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor
TVPE OF CONSTRUCTION LJ NEW LJ ADD {�ALTERATION IJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH
DESC�RI�PT�IONOFWORK/U$ OFBLDG.—� .�:�/
/^�'—��+q I
TVPE OF PER� LJ GRAOING FOUNDATION STRUCTURAI
❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq.FT. OCCUaarvcv ��
CONSTRUCTIONTVPE VALUATIONS F�
4
ZONE GRADINGCU.VDS. ACRES
Bar Sink
Backflow Preventer
Backflow Irri9ation
rinking Fountains
loor Drains
loor Sinks
d5 $CfVIC2 �Ut12L5
Kitchen Sink
Lavatories
P—Trap
Roof Drains
ReinspeMion Fae � $15
Boiler
Duct - Under Grountl
Duct - Structural
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,OOOBT
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa�
Urinal
W2LQ! CIOSEi
Water Heater
Water Service
Auto�Wash
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeratlon System
❑0.100,OOOBTU ❑100,000
System RepaidAlteretion
Fire Dampers
Registers
Issue Fee
N.Y. 9F
S Main Building:
E
T Front
ARear
C Right
gLeft
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW
Reinspection Fee
2one
Accessory
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter Llup to 100 amps
Meter �over 100 amps
Sub Panel -t
Motors Oa1 HP �7'/, - e
Inc.Soiar �9-75 HP 016-15+
Microwave
Pole Light
Range
Standing Sections
15 KW Trash Compactor
$15 luue Fee
FEES
$ 3
N
1
N
G
R
E
�
M
T
S.
$ 3 DEVELOPMENTSERVICESRE�UIREMENTS:
ZoninB APP�oved By Data
FEES Building Approved By Date
Appliption Ittued By Data ^2� "�
SUMMARV OF FEES
� BUILDING PERMIT $ _7�,�.�� � SMIP $ �_
PLAN CHECK $ ��_ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
E�ECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTA�FEE $ '�
PLAN CHECK 25% $
$3�„
\\\ �l Q�Pn3^?=-CRn4�;.�.ii -,yy-r
? D�TE� �°i_.��i 'i..= '_�;..
CONSTRUCTION AND PLANNING :t'� . POOL" A
A?PROVALS Permit# Uate Inspector AppROVALS Permit# Date Inspector
r�; Temporary Electrical Service or Pole �' S2. Pool & Equipment Location
2. Soil Pipe'-Undrgrnd. � 53. Steel Reinforcement �
3:�Electrical ConduiE Utility-Undrgrnd: 54. Forms
4.'Electrtcal Condu�,t-Undrgrnd. .' 55. Electrical Bonding
5.,Steet.REinfarcement� ' 56. Rough Plumbing & Pressure Test
.-,�
�6��Electrical UFER G�nd. � 57. APPROVAL�TO COVER-GUNITE
7t.Footing's� � � • • 58. Electrical Condui[-Undrgrnd.
8f�Foun{latfon � � 59. Gas Pipe, O Undrgrnd., Test �
o� „
9:'Water Pipe-Undrgrncl,. 60. Backwash Lines, P-Trap, O Undrgrnd.
.�
10. �Structural Floor Sys4em � 61. APPROVAL TO DECK
11. Prdperty;Sewer Lipe�& HouseCo'nnection ' 62. Backwash & Receptor-Final
�. .
12. Sewe[ Cap '; o, - 63. Heater & Vent-Final '
;� 3_ �.� �l
13. Roof;Drains �� �� ' •
� ^ �•` . 64. Plumbing SYstem - Final
74. Rougb Plumbing�. 65. Electrical-Final
15. Rough EI'ectrical-CondLit '" 66. Solar System-Final
16. Rough Electric Wirin9 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough _EPectrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough 1-12ating & Air Conditioning FIRE DEPT. REQUIREMENT
�20� Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in;Structure . 70. Underground Hydro
�. �
22. Ducts, Veniilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe•;Rough & Test �� 72. Underground Flush
24. Roof Fra'ming 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing ' 74. Overhead Hydro
26. T-Bar'Ceiling (Strucwral) & Monocoat 75. Dry Chemical
27./Frame and Flashing - 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric �, Notes: � �-(G
34. Final Heating & Air Conditioning ��
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final FactorY Fireplace
3S. Final Plumbing
39. Water Service-Final -
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer �
43. Backflow Irrigation �
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �OII
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern CaliFornia Gas Co
51. CERTIFICATE OF OCCUPANCY �
No. Date